Manitoba and Saskatchewan on same page on MS? You decide

Health Minister Theresa Oswald suggested at a news conference last Friday that there wasn't a lot of difference between her province's approach to the so-called 'liberation treatment' for multiple sclerosis sufferers and that of neighbouring Saskatchewan.

That was before Saskatchewan carried through this week with an earlier promise to fund clinical trials for the procedure in that province.

The controversial MS treatment, which is unavailable in Canada, involves unblocking veins to normalize blood flow from the brain. Some Canadian MS sufferers have travelled as far away as Europe, India and Egypt for the procedure and have claimed it has done wonders for their health.

This summer, Saskatchewan Premier Brad Wall said his government was willing to fund clinical trials of the controversial therapy. "We know there's not unanimity amongst the various groups out there about this particular treatment but we know anecdotally, and to some extent empirically, that there's reason for hope here," Wall told the Regina Leader-Post at the time.

Manitoba and other provinces have been under considerable pressure from MS sufferers who are convinced of the effectiveness of the treatment developed by Italian vascular specialist Paolo Zamboni. He has hypothesized that MS may be caused by a narrowing and twisting of veins that drain blood from the brain. It's a condition he has dubbed CCSVI, or chronic cerebrospinal venous insufficiency.

On Friday, Oswald was asked why Manitoba wasn't following Saskatchewan's path in proceeding with clinical trials. She thanked the reporter for asking the question and then suggested the two province's positions weren't that far apart.

Here is her entire answer:

"I can tell you that I met with (Saskatchewan) Health Minister Don McMorris last month when we were (at a health ministers meeting) in Newfoundland-Labrador and was able to clarify a few things with him about their statements about running clinical trials. And he was very clear that Saskatchewan's point of view is not different from the rest of the nation in that they will proceed with clinical trials if and when the evidence says it's appropriate to do so.

"He said...if there's enough evidence through the research community to go forward with clinical trials, 'we as a government would be there to fund it. We haven't said we are conducting clinical trials.' So I think that's an important distinction to make. I think that MS patients, even around the world, think, 'I'm going to run to Saskatchewan because there are clinical trials going on there.' That's not the case. And it really did become clear in the discussion that his view is really similar to the view of health ministers across the nation. And that the evidence must be there to have a safe and ethical clinical trial. He was also very supportive of what CIHR (Canadian Institutes of Health Research) and other experts have said about the importance of a multi-site or a pan-Canadian approach and so he spoke in favour of that as well.

"So I think it's important to clarify that indeed there aren't clinical trials going on anywhere in Canada. There's a project going on in Newfoundland that was announced at that time that isn't a clinical trial either. I think there's been some confusion about that. It's an observational study of a very small group of patients. And what the research experts have told us, and they're not making this up, it's from actual experience on research that was done on the carotid artery, that when a patchwork approach to research is done, it can not only get you no further ahead, it might even put you in reverse. And that is really concerning to me because while we don't have scientific evidence that is compelling to date to say let's pull the trigger on a multi-site clinical trial, we hope it's coming quickly. We do have very compelling anecdotal evidence from people that are travelling to have this so-called liberation therapy. And I believe that these families have the right to know as quickly as possible (whether it works). That includes if the answer is 'No, despite what you think you may feel, that this doesn't work.' And believe me I'm praying that that's not the answer. But if that is the answer, people with MS have the right to know that and as quickly as possible and a multi-site or pan-Canadian approach is the way that it appears, virtually unanimously, is the methodology that needs to be proceeded with. And that's why we're putting our money ($500,000) on the table today saying, yes, when this research comes forward and it says, it's appropriate, safe and ethical to go forward, we don't want to dilly dally, we want the cash on the table so that we can go. That's why we also as health ministers collectively have directed our officials to get ready just in case."

That was Friday. On Tuesday, Saskatchewan announced it was investing $5 million to fund clinical trials for the liberation procedure. The Saskatchewan Party government said it would leave it to Saskatchewan Health Research Foundation to develop the call for clinical trials, and provide the scientific, ethical and financial expertise to manage this initiative on behalf of the government. It said scientists and health experts, not politicians, would make the final decision on whether it was safe to proceed with clinical trials. But it wanted to kick-start the process.

Afterwards, I talked to Don McMorris, Saskatchewan's health minister, on the phone and asked him whether his province, as Oswald suggested, favoured a pan-Canadian approach.

This is what he said: "I would say that our approaches are similar. We would join in with a pan-Canadian clinical trial initiative if there was one, but there isn't. So, as I've said in other interviews, by the time we get 10 provinces, three territories and a federal government all in agreement on proportion timelines and everything else, we'll have ours (trials) completed, I would think."

McMorris also said the province wouldn't necessarily wait for the results of the seven diagnostic tests being carried out, including one in Saskatchewan, before proceeding with clinical trials.

Saskatchewan is establishing an advisory panel, with experts drawn from the province and other jurisdictions, to begin developing a call for proposals for clinical trials. The panel will convene in early November, with an expedited call for proposals occurring in early December. It is expected that the successful recipient will be chosen in early 2011 and a process leading to clinical trials will be announced by April of 2011.

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